Question:
The company I work for has BC/BS of Illinios.

Just found out that there is an enclusion in their policy that states that this surgery is not covered, even if is causing other medical problems does any one esle have this problem? Can anything be done aout it?    — [Anonymous] (posted on August 15, 2001)

August 15, 2001
<p><font color=purple>I have Blue Cross Blue Shield of Oregon and have a clear exclusion as well. Check out my profile and you'll see what my exclusion is and what I'm doing.<p>No info on whether or not I can get this paid but I'm appealing and getting legal help. Let me know if there is anything I can help you with. Email me at</font><font color=blue>[email protected]</font><p>
   — Dawn R.

August 15, 2001
I have Trigon BC/BS in VA... and they actually have an inclusiong to their exclusion. It reads exactly as followed, "Your coverage does not include benefits for care of OBESITY or services related to weight loss or dietary control, even if there is a related medical problem, except for morbid obesity as outlined...in this book..." so you go to the page of inclusions and about morbid obesity and it says, "Your health plan covers treatment of morbid obesity through gastric bypass, or other methods recognized by the National Institues of Health (NIH). Coverage is restricted to surgical procedures and does not include weight control dietary supplements. According to the NIH guidelines, gastric bypass surgery is effective for the long-term reversal of morbid obesity for a patient who: - weighs at least 100 poinds over or twice the ideal body weight; - has a body mass index equal to or greater than 35kgms per meter squared, with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or - has a body mass index of 40kgms per meter squared, without such comorbidity." So, stating that... there is hope. Maybe you should give them a call to see if perhaps they have the same inclusion to their exclusion! Good Luck!!!
   — [Anonymous]